HEALTH: Saving lives for the price of a cup of coffee

LONDON, 14 June 2011 (IRIN) - The Global Alliance for Vaccines and Immunization, (GAVI) has succeeded in raising more than enough money to fund its programme for the next five years.

The organization had asked donors for US$3.7 billion, enough to immunize more than 250 million children in the world’s poorest countries, a programme which would, it estimated, save more than four million young lives. In the event donors - both governmental and private - pledged $4.3 billion, at a meeting in London hosted by the British and Liberian governments and the Bill and Melinda Gates Foundation.

The new pledges included a billion dollars from the Gates Foundation, and 1.33 billion from the British government. Norway will give $677 million, and the USA overcame its reservations about multi-year financing to offer $450 million. The administrator of USAID, Raj Shah, said making a multi-year pledge was what he called a “challenging step”, but recognized that this kind of five-year commitment meant GAVI could drive a harder bargain with the vaccine manufacturers and so get better value for money.

Bill Gates told a news conference after the meeting that they had hoped donors would push themselves to be generous, and that was exactly what had happened. He particularly welcomed new donors, such as Brazil (which contributed 12 million dollars), and Japan, which he said still wanted to be part of the project, despite the particular challenges it currently faced. Four hours was a long meeting, he told journalists at the end of the session. “But if you can save four million lives in four hours, it’s well worth every minute.”

The funding means GAVI can support qualifying countries (those with a per capita gross national income of less than $1,500) to maintain their current vaccination programmes and, in addition, start rolling out vaccination programmes against two of the leading killers of small children, pneumonia and diarrhoea.

Nineteen countries have already been approved for GAVI funding for the vaccine against pneumococcal disease, and five for a rotavirus vaccine to prevent the most deadly form of diarrhoea.

HPV vaccine for Senegal

Senegal’s health minister, Modou Diagne Fada, told IRIN he was eager to introduce the two new vaccines, and also wanted to have the vaccine against HPV - the Human Papilloma Virus, which can lead to cervical cancer in women - available by 2015.

He said patterns of disease were changing in Senegal: “Malaria is no longer our biggest killer. Now we have problems of chronic disease, and non-transmissible diseases like cancer. Among those there is one very deadly cancer, cancer of the cervix, and we believe that if we can get the HPV vaccine, we will be able to save the lives of our women.”

Rotavirus, which causes severe diarrhoea, kills more than half a million children a year

At a time when the global financial crisis is putting a squeeze on aid budgets, vaccination programmes clearly remain popular with donors. Partly it is the magic of the thought that - as the UK’s Secretary for International Development Andrew Mitchell put it - you can save a child’s life for the price of a cup of coffee. But it is also because vaccinations can be counted, targets can be verified and outcomes measured in the form of reduced incidence of disease.

Asked by IRIN about the attraction of this kind of aid for donors, Mitchell said: “The British government set up an examination of all 43 multilateral agencies through which taxpayers’ money is spent in development. From some we removed money and with others we froze money, but GAVI is one of the best… It’s absolutely brilliant value for money… 80 percent of its funding is spent on vaccines… It’s very cost effective. And we owe it to taxpayers in Britain to ensure that every penny we spend is really used to secure these brilliant results.”

Middle income countries - a potential problem?

Paradoxically, this enthusiasm can have its drawbacks if vaccination becomes too closely identified with international donors. Last week one paper in a special vaccination edition of the medical journal, the Lancet, identified a potential problem as more nations pass the threshold to become classed as middle-income countries, and then the slightly higher threshold for GAVI funding.

One of its authors, Orin Levine of the Johns Hopkins School of Public Health, told journalists that this had big implications for vaccination programmes. “Most of the world’s poor people are now living in middle-income countries. Those countries have some means; they are not poor enough to qualify for GAVI support and generally don’t qualify for the preferential pricing arrangements of the kind announced by drug companies last week. This is going to be an increasing challenge to tackle in the years ahead.”

GAVI does in fact have a system of co-financing by which eligible countries have to buy some of their vaccines themselves, paying the equivalent of 10-30 US cents per dose, gradually increasing as their national wealth increases. GAVI said that as part of this pledging round, developing countries had committed themselves to maintain or increase the co-financing of their vaccine programmes.

Beyond compulsory vaccination

The other risk is that vaccination becomes not just something international donors do for you, but something they do to you. Another Lancet author, Heidi Larson of the London School of Hygiene and Tropical Medicine, has studied the reasons why some parents resist having their children vaccinated. When she visited the very marginalized areas in northern Nigeria where the revolt against polio vaccine started in 2003 she found people bemused and suspicious about why outsiders kept coming and insisting on this particular intervention, when they were reluctant to help with things people really felt they needed: “Why are they always giving us this polio vaccine, they said, “when that’s not our big problem?”

Scientific explanations clearly do not address this kind of feeling. Larson stresses that resistance to vaccination, right from the very early days, has been as much, or more, about compulsion than about the vaccine itself. “And no health intervention,” she says, “is so government regulated as vaccination”.

To those who understand it, the virtues of vaccination are so self-evident that pressure to vaccinate is justified. In Ethiopia, vaccinating your children is compulsory. In India vaccination teams pursue travellers with babies even on to trains and station platforms. Science continues to advance, and thanks to today’s replenishment, funding is now assured, but people have to be involved and their concerns listened to if vaccination is to achieve its fullest benefits.

HEALTH: Saving lives for the price of a cup of coffee

LONDON, 14 June 2011 (IRIN) - The Global Alliance for Vaccines and Immunization, (GAVI) has succeeded in raising more than enough money to fund its programme for the next five years.

The organization had asked donors for US$3.7 billion, enough to immunize more than 250 million children in the world’s poorest countries, a programme which would, it estimated, save more than four million young lives. In the event donors - both governmental and private - pledged $4.3 billion, at a meeting in London hosted by the British and Liberian governments and the Bill and Melinda Gates Foundation.

The new pledges included a billion dollars from the Gates Foundation, and 1.33 billion from the British government. Norway will give $677 million, and the USA overcame its reservations about multi-year financing to offer $450 million. The administrator of USAID, Raj Shah, said making a multi-year pledge was what he called a “challenging step”, but recognized that this kind of five-year commitment meant GAVI could drive a harder bargain with the vaccine manufacturers and so get better value for money.

Bill Gates told a news conference after the meeting that they had hoped donors would push themselves to be generous, and that was exactly what had happened. He particularly welcomed new donors, such as Brazil (which contributed 12 million dollars), and Japan, which he said still wanted to be part of the project, despite the particular challenges it currently faced. Four hours was a long meeting, he told journalists at the end of the session. “But if you can save four million lives in four hours, it’s well worth every minute.”

The funding means GAVI can support qualifying countries (those with a per capita gross national income of less than $1,500) to maintain their current vaccination programmes and, in addition, start rolling out vaccination programmes against two of the leading killers of small children, pneumonia and diarrhoea.

Nineteen countries have already been approved for GAVI funding for the vaccine against pneumococcal disease, and five for a rotavirus vaccine to prevent the most deadly form of diarrhoea.

HPV vaccine for Senegal

Senegal’s health minister, Modou Diagne Fada, told IRIN he was eager to introduce the two new vaccines, and also wanted to have the vaccine against HPV - the Human Papilloma Virus, which can lead to cervical cancer in women - available by 2015.

He said patterns of disease were changing in Senegal: “Malaria is no longer our biggest killer. Now we have problems of chronic disease, and non-transmissible diseases like cancer. Among those there is one very deadly cancer, cancer of the cervix, and we believe that if we can get the HPV vaccine, we will be able to save the lives of our women.”

Rotavirus, which causes severe diarrhoea, kills more than half a million children a year

At a time when the global financial crisis is putting a squeeze on aid budgets, vaccination programmes clearly remain popular with donors. Partly it is the magic of the thought that - as the UK’s Secretary for International Development Andrew Mitchell put it - you can save a child’s life for the price of a cup of coffee. But it is also because vaccinations can be counted, targets can be verified and outcomes measured in the form of reduced incidence of disease.

Asked by IRIN about the attraction of this kind of aid for donors, Mitchell said: “The British government set up an examination of all 43 multilateral agencies through which taxpayers’ money is spent in development. From some we removed money and with others we froze money, but GAVI is one of the best… It’s absolutely brilliant value for money… 80 percent of its funding is spent on vaccines… It’s very cost effective. And we owe it to taxpayers in Britain to ensure that every penny we spend is really used to secure these brilliant results.”

Middle income countries - a potential problem?

Paradoxically, this enthusiasm can have its drawbacks if vaccination becomes too closely identified with international donors. Last week one paper in a special vaccination edition of the medical journal, the Lancet, identified a potential problem as more nations pass the threshold to become classed as middle-income countries, and then the slightly higher threshold for GAVI funding.

One of its authors, Orin Levine of the Johns Hopkins School of Public Health, told journalists that this had big implications for vaccination programmes. “Most of the world’s poor people are now living in middle-income countries. Those countries have some means; they are not poor enough to qualify for GAVI support and generally don’t qualify for the preferential pricing arrangements of the kind announced by drug companies last week. This is going to be an increasing challenge to tackle in the years ahead.”

GAVI does in fact have a system of co-financing by which eligible countries have to buy some of their vaccines themselves, paying the equivalent of 10-30 US cents per dose, gradually increasing as their national wealth increases. GAVI said that as part of this pledging round, developing countries had committed themselves to maintain or increase the co-financing of their vaccine programmes.

Beyond compulsory vaccination

The other risk is that vaccination becomes not just something international donors do for you, but something they do to you. Another Lancet author, Heidi Larson of the London School of Hygiene and Tropical Medicine, has studied the reasons why some parents resist having their children vaccinated. When she visited the very marginalized areas in northern Nigeria where the revolt against polio vaccine started in 2003 she found people bemused and suspicious about why outsiders kept coming and insisting on this particular intervention, when they were reluctant to help with things people really felt they needed: “Why are they always giving us this polio vaccine, they said, “when that’s not our big problem?”

Scientific explanations clearly do not address this kind of feeling. Larson stresses that resistance to vaccination, right from the very early days, has been as much, or more, about compulsion than about the vaccine itself. “And no health intervention,” she says, “is so government regulated as vaccination”.

To those who understand it, the virtues of vaccination are so self-evident that pressure to vaccinate is justified. In Ethiopia, vaccinating your children is compulsory. In India vaccination teams pursue travellers with babies even on to trains and station platforms. Science continues to advance, and thanks to today’s replenishment, funding is now assured, but people have to be involved and their concerns listened to if vaccination is to achieve its fullest benefits.